Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Am J Prev Med. 2022 Dec;63(6):1007-1016. doi: 10.1016/j.amepre.2022.07.009. Epub 2022 Sep 2.
The relationships between healthcare use and social needs are not fully understood. In 2015, International Classification of Diseases, Tenth Revision coding introduced voluntary Z codes for social needs‒related healthcare encounters. This study evaluated early national patterns of Z codes in privately insured adults.
In 2021, the authors conducted a case-control analysis of national commercial health payer claims from 2016 to 2019. Among adults with ≥6 months of continuous enrollment and ≥1 medical claims, patients with any assigned Z codes were defined as cases. Controls were selected through stratified random sampling. Z codes were organized under 3 categories: socioeconomic, community/social, and environmental.
Of 29.5 million adults, 521,334 patients (1.8%) had any assigned Z codes. Among all the Z codes, 53.5% identified community/social issues, 30.3% identified environmental issues, and 16.2% identified socioeconomic issues. Among socioeconomic Z codes, housing needs were frequently identified, but needs for food, utility bills, and transportation were very rarely identified. In multivariable regression analysis, females had higher odds of Z code assignment than males. Depression and chronic pulmonary disease were the 2 common comorbidities (≥5% prevalence in cases and controls) that were highly associated with Z code assignment. Less common comorbidities strongly associated with Z code assignment were drug abuse, alcohol abuse, psychoses, and AIDS/HIV.
In this national study of privately insured patients, many Z codes identified healthcare encounters caused by social stressors, whereas few identified food- or transportation-related causes. Depression and chronic pulmonary disease were highly associated with Z code assignment.
医疗保健的使用与社会需求之间的关系尚未完全阐明。2015 年，国际疾病分类第十次修订版引入了用于与社会需求相关的医疗保健就诊的自愿 Z 编码。本研究评估了 2016 年至 2019 年期间私人保险成年人中 Z 编码的早期全国模式。
2021 年，作者对来自 2016 年至 2019 年的全国商业健康支付者索赔进行了病例对照分析。在至少有 6 个月连续参保和至少有 1 次医疗索赔的成年人中，任何 Z 编码的患者被定义为病例。通过分层随机抽样选择对照。Z 编码分为社会经济、社区/社会和环境 3 类。
在 2950 万成年人中，有 521334 名患者（1.8%）有任何分配的 Z 编码。在所有 Z 编码中，53.5%的编码识别社区/社会问题，30.3%的编码识别环境问题，16.2%的编码识别社会经济问题。在社会经济 Z 编码中，住房需求经常被识别，但食物、水电费和交通方面的需求很少被识别。在多变量回归分析中，女性 Z 编码分配的可能性高于男性。抑郁症和慢性肺部疾病是与 Z 编码分配高度相关的 2 种常见合并症（病例和对照中的患病率均≥5%）。与 Z 编码分配密切相关的不太常见的合并症包括药物滥用、酒精滥用、精神病和艾滋病/艾滋病毒。
在这项针对私人保险患者的全国性研究中，许多 Z 编码确定了由社会压力源引起的医疗保健就诊，而很少确定与食物或交通相关的原因。抑郁症和慢性肺部疾病与 Z 编码分配高度相关。
